4 ms·

Potential Gains in Life Expectancy Associated with Diabetes Treatment Goals [pdf]

38 points by luu 5y ago

pgt 5y ago
Life expectancy gains of ”3.9, 3.8, 1.9, and 0.9, respectively,” seem low for a major intervention, but mean age was 65.6. Not sure how gains stack when combined, if at all.
- wardedVibe 5y ago
  > We then estimated the LE for patients from each quartile and the LE if patients from each quartile improved 1 of their biomarker levels to the next lower quartile while keeping other biomarkers constant. Sounds like its additive, so potentially up to 10 years if you're going from the worst quartiles in everything to the best, though I suspect that is extremely difficult. I am a bit surprised by the relative unimportance of HbA1C. I guess mortality is different that QALYs, which losing toes/eyes definitely affect, even if they don't kill you.
fswd 5y ago
only one mention of metformin, and it's a title to a paper in the references. however, diabetics who take metformin live longer than diabetics who didn't and nondiabetics in general. the paper didn't take that in consideration that some of the people could be on this seemingly diabetic drug
- rnk 5y ago
  I'm skeptical about your statement - diabetics who take metformin '.. live longer than non-diabetics in general'. I don't believe that is true. There is lots of research about metformin helping people, but making diabetics live longer than non-diabetics seems too far a reach. Can your provide a citation for this? I am not a diabetic, I tried to convince my doctor to let me take metformin but she thought there were some risks (such as a the recent papers on it causing birth defects in the children of men who were taking it - https://www.cnn.com/2022/03/28/health/paternal-metformin-use-birth-defects/index.html https://www.cnn.com/2022/03/28/health/paternal-metformin-use...
  - ndr 5y ago
    I'm not sure this is the best of sources, but it's a piece of information David Sinclair tends to bring up: https://pubmed.ncbi.nlm.nih.gov/25041462/#:~:text=Conclusions%3A%20Patients%20with%20type%202,and%20those%20receiving%20metformin%20monotherapy https://pubmed.ncbi.nlm.nih.gov/25041462/#:~:text=Conclusion....
    - vannevar 5y ago
      I'm skeptical of the benefits claimed for non-diabetics: the 15% difference in median survival time between metformin-using diabetics and control "non-diabetics" may just indicate undiagnosed diabetes in the control population. The abstract doesn't say how the controls were selected, whether they were verified to not have diabetes or were simply people with no diabetes diagnosis.
  - saurik 5y ago
    Just search Hacker News for metformin: it is actually discussed quite a lot, and there are tons of posts about this effect (whether it is actually true or not I don't know, but like: the citations you seek are extremely easy to find if you just take a few seconds to look).
_7gt4 5y ago
I'm sure the amount of stress I've been exposed to from being yelled at by my physician "that i need to change or die young" at my diagnosis is pretty on par with this decreased life expectancy. Not to mention I now have a general dislike for doctors and avoid them as much as possible, because inevitably everything I'd complain about would be blamed on excess weight or trans broken arm. Love to see how empathetic doctors affect life expectancy. I'd assume quite a lot.
- djmips 5y ago
  IKR? Like they can't get past that one thing. I think it even blinds them to help you with other things. Like they'll probably miss a cancer diagnosis.
  - _7gt4 5y ago
    Hah, yeah. I had a big AFH tumor on my hand. "Probably ganglion". Thankfully these things rarely turn into full blown cancer and I got someone to take it serious (but only after it started necrotizing) before it did.
- krageon 5y ago
  In their defense, if you're very fat that's probably going to cause most of your issues. Perhaps after a while repeatedly diagnosing things with the same root cause is going to frustrate your doctor as well. How about a little empathy for them? No need to lose weight, but also no need to bother them with it then. Which is essentially what you're doing, a net win for everyone :)
  - _7gt4 5y ago
    They call it "trans broken arm syndrome" because this shit includes things that are obviously NOT hormone/obesity related. Things anyone else would get an immediate MRI for. Exactly the kind of thoughtless answer that presumes I'm just angry about being told the hard truth or something I needed. Being obese does NOT IN FACT lower your risk of every disease (except apparently heart failure?) that is not caused by obesity. Obese people need doctors for non-obesity related issues too.

38 points by luu 5y ago

pgt 5y ago

Life expectancy gains of ”3.9, 3.8, 1.9, and 0.9, respectively,” seem low for a major intervention, but mean age was 65.6. Not sure how gains stack when combined, if at all.

wardedVibe 5y ago
> We then estimated the LE for patients from each quartile and the LE if patients from each quartile improved 1 of their biomarker levels to the next lower quartile while keeping other biomarkers constant. Sounds like its additive, so potentially up to 10 years if you're going from the worst quartiles in everything to the best, though I suspect that is extremely difficult. I am a bit surprised by the relative unimportance of HbA1C. I guess mortality is different that QALYs, which losing toes/eyes definitely affect, even if they don't kill you.

fswd 5y ago

only one mention of metformin, and it's a title to a paper in the references. however, diabetics who take metformin live longer than diabetics who didn't and nondiabetics in general. the paper didn't take that in consideration that some of the people could be on this seemingly diabetic drug

rnk 5y ago
I'm skeptical about your statement - diabetics who take metformin '.. live longer than non-diabetics in general'. I don't believe that is true. There is lots of research about metformin helping people, but making diabetics live longer than non-diabetics seems too far a reach. Can your provide a citation for this? I am not a diabetic, I tried to convince my doctor to let me take metformin but she thought there were some risks (such as a the recent papers on it causing birth defects in the children of men who were taking it - https://www.cnn.com/2022/03/28/health/paternal-metformin-use-birth-defects/index.html https://www.cnn.com/2022/03/28/health/paternal-metformin-use...
- ndr 5y ago
  I'm not sure this is the best of sources, but it's a piece of information David Sinclair tends to bring up: https://pubmed.ncbi.nlm.nih.gov/25041462/#:~:text=Conclusions%3A%20Patients%20with%20type%202,and%20those%20receiving%20metformin%20monotherapy https://pubmed.ncbi.nlm.nih.gov/25041462/#:~:text=Conclusion....
  - vannevar 5y ago
    I'm skeptical of the benefits claimed for non-diabetics: the 15% difference in median survival time between metformin-using diabetics and control "non-diabetics" may just indicate undiagnosed diabetes in the control population. The abstract doesn't say how the controls were selected, whether they were verified to not have diabetes or were simply people with no diabetes diagnosis.
- saurik 5y ago
  Just search Hacker News for metformin: it is actually discussed quite a lot, and there are tons of posts about this effect (whether it is actually true or not I don't know, but like: the citations you seek are extremely easy to find if you just take a few seconds to look).

_7gt4 5y ago

I'm sure the amount of stress I've been exposed to from being yelled at by my physician "that i need to change or die young" at my diagnosis is pretty on par with this decreased life expectancy. Not to mention I now have a general dislike for doctors and avoid them as much as possible, because inevitably everything I'd complain about would be blamed on excess weight or trans broken arm. Love to see how empathetic doctors affect life expectancy. I'd assume quite a lot.

djmips 5y ago
IKR? Like they can't get past that one thing. I think it even blinds them to help you with other things. Like they'll probably miss a cancer diagnosis.
- _7gt4 5y ago
  Hah, yeah. I had a big AFH tumor on my hand. "Probably ganglion". Thankfully these things rarely turn into full blown cancer and I got someone to take it serious (but only after it started necrotizing) before it did.
krageon 5y ago
In their defense, if you're very fat that's probably going to cause most of your issues. Perhaps after a while repeatedly diagnosing things with the same root cause is going to frustrate your doctor as well. How about a little empathy for them? No need to lose weight, but also no need to bother them with it then. Which is essentially what you're doing, a net win for everyone :)
- _7gt4 5y ago
  They call it "trans broken arm syndrome" because this shit includes things that are obviously NOT hormone/obesity related. Things anyone else would get an immediate MRI for. Exactly the kind of thoughtless answer that presumes I'm just angry about being told the hard truth or something I needed. Being obese does NOT IN FACT lower your risk of every disease (except apparently heart failure?) that is not caused by obesity. Obese people need doctors for non-obesity related issues too.